A 72-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with sudden onset of shortness of breath and chest pain on the right side. On examination, you note diminished breath sounds on the right and the trachea is deviated towards the left. The patient is tachycardic and increasingly anxious. Which of the following is the most appropriate immediate management?
Urgent consultation with a pulmonologist
Calling for a portable chest x-ray
Administration of high-flow oxygen and reassessment in 15 minutes
Immediate needle decompression followed by chest tube thoracostomy
In a patient presenting with shortness of breath, unilateral chest pain, diminished breath sounds, and tracheal deviation, the clinical suspicion for tension pneumothorax is high. Immediate needle decompression is required to relieve the pressure in the pleural space. This is a time-sensitive emergency, and failure to act promptly can lead to significant hemodynamic instability and cardiac arrest. Chest tube thoracostomy is performed subsequent to needle decompression for ongoing management. Administration of high-flow oxygen and monitoring vitals are supportive measures and would not address the immediate life-threatening condition. Calling for a chest x-ray would delay the urgent intervention needed for a suspected tension pneumothorax.
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Respiratory Emergencies
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